Serum alpha-fetoprotein in the early stage of human hepatocellular carcinoma

The serum alpha-fetoprotein levels of 17 patients with cancers less than or equal to 3 cm in size were studied using radioimmunoassay to determine alpha-fetoprotein response in the early stage of human hepatocellular carcinoma. The levels were normal in 6 patients (35%), and elevated to 645 +/- 1140 micrograms/L (mean +/- SD) in the remaining patients. The levels were not correlated with tumor size. In 10 surgically resected patients, 5 had elevated levels of alpha-fetoprotein that returned to normal after surgery. The levels and tumor sizes were serially observed for 3-26 mo in the remaining 7 patients not surgically treated. In 1 patient alpha-fetoprotein levels were persistently normal and in the other 6 patients, the levels tended to increase with a median doubling time of 60-75 days (range 30-223 days). Despite continued tumor growth, a spontaneous fall in serum alpha-fetoprotein levels was encountered in 4 patients; in 2 patients the levels even fell within the normal range. After this fall, the levels increased drastically in 4 patients. We concluded that in the early stage of hepatocellular carcinoma, serum alpha-fetoprotein level is frequently normal, and thus determination of serum alpha-fetoprotein levels only is not a reliable indicator in the early detection of human hepatocellular carcinoma. A spontaneous fall in the level of alpha-fetoprotein is not an uncommon finding in the early stages of this cancer and cannot be used to rule out the diagnosis of hepatocellular carcinoma.

Clinical and immunopathologic study of mesangial IgM nephropathy: report of 41 cases

Forty-one out of 408 cases (or 10%) of primary glomerular disease had diffuse fine granular to arc-like short linear mesangial deposits of IgM by direct immunofluorescence. The IgM deposition was accompanied by C1q and/or C4 in the same locality in 29 cases, by C3 in 10, and by trace amounts of IgA in 6. Properdin-factor B was not detected. Fine granular electron dense deposits of low density were detected in the mesangium in all 41 cases by electron microscopy, usually as a discrete granular or arc-like pattern beneath the mesangial glomerular basement membrane and correlated well with the immunofluorescence findings. An immune complex disease with complement activation via the classical pathway is suggested. The ages of the patients varied from 2 to 58 years (average 23.8 years). A male predominance of 2.2:1 was identified. Serum IgM level was elevated in 46.7% of the cases. The majority (87.8%) of the cases manifested a nephrotic syndrome or relapse at time of biopsy, and the remaining cases experienced persistent or intermittent proteinuria. Among the 36 nephrotic patients, 22 cases (61.1%) demonstrated complete remission with steroid therapy, 9 cases (25%) were resistant, and 5 cases (13.9%) had partial remission. Complete and partial remissions were later achieved with cytotoxic drugs or methylprednisolone pulse therapy in 3 and 4 cases respectively in the steroid resistant patients. Frequent relapses occurred during the course in 22 out of 32 cases (68.8%) who had experienced complete or partial remission. Follow-up study after biopsy demonstrated that sustained complete remission was achieved with prednisolone with or without cytotoxic drugs and pulse therapy in only 14 (42.4%) of the 33 nephrotic cases who had been followed up for longer than 6 months, and six of them had had previous relapses. Pathologically, 56.1% of the patients showed mild to moderate increase in mesangial matrix and cellularity. Focal and segmental sclerosis was demonstrated in four cases (9.8%). However, minimal glomerular change was also common (34.1%). The patients with minimal change seemed to have a higher complete remission rate than patients with more evident glomerular alterations, although the difference was not statistically significant. This clinical and immunopathological study suggests that mesangial IgM nephropathy is an important disease in Taiwan, with a variable response to treatment and frequent relapses.(ABSTRACT TRUNCATED AT 400 WORDS)

Fraternal hepatocellular carcinoma in young children in two families

Two pairs of young brothers from two families with histologically verified hepatocellular carcinoma (HCC) occurred with almost simultaneous onset in each family. In the first family, the boys were 5 and 7 years of age, respectively. Both of them, their parents, and a younger sister were hepatitis-B-surface-antigen (HBsAg)-positive. In the second family, the two brothers were 9 and 7 years of age, respectively. Both patients, their mother, and maternal grandmother were HBsAg-positive. The fraternal occurrence of HCC in children under the age of 10 years has not been reported in the literature. The pattern of HBsAg on these families suggests the HCC cases were infected by their mothers, most possibly in the perinatal period, and is additional support for the important role of hepatitis-B virus in the etiology of HCC. The very early and almost simultaneous onset, however, suggests that additional genetic and/or environmental factors are also important.

Hepatitis-B surface antigen and hepatocellular carcinoma in Taiwan. With special reference to types and localization of HBsAg in the tumor cells

The relationship between hepatitis B virus (HBV) infection and hepatocellular carcinoma (HCC), with or without cirrhosis, was assessed immunopathologically through the detection of tissue hepatitis B surface antigen (HBsAg) on paraffin sections of 284 biopsy and surgical specimens of HCC, which were performed from 1970 to 1979, by the indirect immunoperoxidase technique. In 190 cases with nontumorous liver tissue available for histologic and etiologic analyses, cirrhosis was identified in 69.8% (37 of 53) in needle biopsy, 67.4% (31/46) in wedge, and 30.8% (28/91) in the resection or lobectomy group. HBsAg was detected in the nontumorous liver parenchyma in 85.7% in the whole series, and 90.6% in the cirrhotic cases (96.8% in wedge and 100% in resection cases). The HBsAg positivity in the noncirrhotic cases of the resection group was 84.1% (53/63), whereas the 10 negative cases in this group were all noncirrhotic. This clearly demonstrates a strong association of HBsAg and HCC in both cirrhotic and noncirrhotic patients in Taiwan, particularly in the cirrhotic group, as evidenced by the high prevalence of HBsAg in wedge and resection series. On the other hand, the etiology in the HBsAg-negative and noncirrhotic group, which also had a less evident male predominance (male:female = 3.3:1 versus 6-19.5:1) and significantly less liver cell dysplasia than HBsAg-positive or cirrhotic groups, remains to be explained. In 223 cases where tumor tissue met the minimal requirement for analysis, HBsAg was demonstrated in 27 cases (12.1%) in the tumor cells (15% in the resection group). This investigation indicates an important etiologic role of HBV in hepatocellular carcinogenesis, and the development of HCC does not depend on the coexistence of cirrhosis in Taiwan.

Association of hepatitis B surface (HBs) antigenemia and membranous nephropathy in children in Taiwan

Fourteen out of 63 children with primary glomerular disease had membranous nephropathy (MN) that was not associated with systemic lupus erythematosus. Hepatitis B surface antigen (HBsAg) was detected in the sera of all 13 patients tested, but was found in only 6.25% of their parents, in 28.57% of their siblings, and in 18.8% of the children with other types of primary glomerular disease. These findings strongly suggest that MN in children in Taiwan is closely related to hepatitis B virus (HBV) infection, and that, in most, if not all, instances it is due to horizontal infection rather than vertical transmission. However, the antigen antibody system involved remains to be identified. In this study, 4 out of 12 cases also showed abnormal elevation of SGOT and SGPT. Liver biopsies obtained from 9 patients demonstrated chronic persistent hepatitis in 3 cases, focal necrosis in 2, and minimal change or normal histology in 4. Although both the liver and kidney diseases appeared to be relatively benign during a limited period of observation, the long-term influence of the diseases and their final outcomes remain to be clarified. With the strong association of HBs antigenemia and MN in children, and the high incidence of HBsAg-positive chronic hepatitis in MN, an investigation of liver function and HBsAg carriage in patients with MN and a study of renal function in HBsAg carriers are highly recommended.

Measles and acute glomerulonephritis

A 5-year-old boy had transient glomerulonephritis following measles infection. Serologic studies at the early onset of the disease showed decrease of serum C3, C4, and Clq levels with normal serum properdin factor B. Renal glomerular histology revealed a mild acute proliferative glomerulonephritis. Measles virus antigen, C3, C4, and immunoglobulin G (IgG) were demonstrated in the glomerulus, suggesting an immune complex deposition. Ultrastructurally, subepithelial, intramembranous, and subendothelial electron-dense deposits were noted, suggesting a postinfectious immune complex glomerulonephritis. It is suggested that the measles virus antibody complexes are deposited in the glomerulus and activate the classic pathway of complement, leading to a self-limited glomerulonephritis.

Cyclophosphamide-induced glomerular injury in newborn mice

The glomeruli of newborn mice from mothers given a single intraperitoneal injection of cyclophosphamide (50 or 110 mg. per kg.) showed varying degrees of mesangiolysis and subsequent diffuse mesangial and segmental sclerosis. The sclerosis was preceded by the formation of a considerable amount of mesangial microfibrils. This change was accompanied by a marked subendothelial widening of the glomerular capillary and an increase in the number of microfibrils in this space. These results support our previous notion that glomerular microfibrils play an important role in the process of glomerular repair. The results also show that cyclophosphamide can induce injury in the developing glomeruli of newborn mice.

Ultrastructure of transplant glomerulopathy

Thirty-one specimens of tissue were obtained from 15 renal allografts 3-96 months after transplantation and studied by light, electron and in some cases also by immunofluorescence microscopy. All patients had a degree of renal insufficiency and almost all had proteinuria and moderate hypertension; nephrotic syndrome was present in one and hematuria in two. On histological examination one patient showed cellular proliferation suggestive of glomerulonephritis (recurrent or de novo) and another patient had numerous crescents. The most frequent glomerular lesion was widening of the lamina rara interna with subendothelial accumulation of finely granular material, formation of new subendothelial basement membrane and deposition of microfibrils and fine filaments. The mesangial changes were mainly those of mesangiolysis and mesangial sclerosis with deposition of mesangial matrix and microfibrils, but little cellular proliferation. Fragmented red blood cells were seen in nearly half of the patients. In another seven patients the lesion resembled focal segmental glomerulosclerosis. This combination of changes termed transplant glomerulopathy leads to diffuse glomerular sclerosis. Arterial intimal thickening and occasionally also thrombosis produced ischaemic changes in the kidney and in the glomeruli and contributed significantly to the process of transplant rejection.

[Common variable immunodeficiency: an immunological study (author's transl)]

A 17-year-old school boy with recurrent sinopulmonary infection and diarrhea was found to have marked hypogammaglobulinemia. He had no family history of similar disorder. Serum IgG was measured 240 mg/dl, whereas all the other classes of immunoglobulins were undetectable with Mancini's technique. The polymorphonuclear leukocyte function and complement system were normal. Although the numbers of T and B lymphocytes were normal, we demonstrated that the patient's B cells were able to produce only IgG in subnormal amount and unable to secrete other classes of immunoglobulins. No hyperactive suppressor T cell function or inadequate helper T cell function was found. Therefore, the basic immmunopathogeneic mechanism was ascribed to intrinsic B cell defect.

Glomerular microfibrils in renal disease: a comparative electron microscopic study

Microfibrils are a common component of connective tissue that have been described only rarely in the renal glomerulus. Structurally, microfibrils are fibrotubules with an average diameter of 12 nm, a lucid core, and a dark periphery. High resolution electron microscopy, including stereo microscopy performed on renal biopsy tissues, demonstrated the presence of microfibrils under the endothelium of the capillary walls and in the mesangium in several glomerular diseases. These diseases were characterized by widening of lamina rara interna or separation of the endothelium from the basement membrane, among them transplant glomerulopathy, focal segmental glomerulosclerosis (including a case associated with Marfan syndrome), preeclamptic toxemia, and less frequently hemolytic-uremic syndrome and malignant hypertension. The number of microfibrils generally correlated with the degree of subendothelial widening.

Role of sustained neurones of cat lateral geniculate nucleus in processing luminance information

The properties of the sustained cells in the lateral geniculate nucleus of cat have been studied quantitatively. These cells may be subdivided into two groups, the brightness and the darkness detectors. The former is photoexcitatory neurone and the latter, photoinhibitory. In both types, the rates of sustained discharges are closely related to the levels of retinal illumination over a range about 4 log units. The receptive fields of sustained cells again can be roughly divided into two subtypes according to their size. The large receptive field cells all belong to darkness detectors and are distributed mostly at retinal periphery, which may play some role in signalling the background luminance. The small receptive field cells comprise all brightness detectors and a part of darkness detectors, which are located predominantly around area centralis and may transmit the message of brightness or darkness about picture details and enhance the boundaries of a two-dimensional figure.